Medroxyprogesterone acetate (MPA) is being used clinically in the management of paraphiliac behavior. It may act centrally or through the suppression of testosterone. Ongoing assessment includes evaluation of patient's psychosocial state, reduction in fantasies leading to compulsive behavior, and biochemical changes, such as a propensity for diabetes or cholelithiasis to develop. The longitudinal outcome vs therapy is being addressed.